HomeMy WebLinkAbout24-5031 POLICETRAFF'c" III !111 IIIllI111IN II II I REPORT NO. EE76814 07,
27
COLLISION REP FIT 1591971
CASE 24-5031 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 05 — 11 — 2024 1459 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 2500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 3 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6� INITIAL
LAST NAME MAI FIRSTNAME XUAN MIDDLE A 1 1 2 31
STREET ❑ 3970 W LAKE SAMMAMISH PKWY NE#211 CITY REDMOND ST WA ZIP' 98052 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES �/ NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 10 — 10 — 2000 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 13 EJECT 2 H USE 5 5 CLASS PELVIC AND LEG POSS FX z❑
3
10 P1 ATNFS# 9G9143 STATE WA u N# MLHPC441OD5003325
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FRom ro
TRLR. TRLR 7 3 33
2 1 ❑ VIN#' VIN#
Rom 34
13� VEH.YEAR 20 13 MAKE HOND MODEL CBR500 STYLE MC IV
AMAGE TOWED NOO pLSABLIN T� I� RS TO EVID VEHICLE�
DAMAGE IILLJJII
REGISTERED OWNER INFO XUA1.13970 WLAKE SAMMAMISH PKWYNE#211 REDMOND WA 98052 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
15❑ vECEHA"LE 5 36
LLLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
STAIN.D'ING 8 7 6
UNIT 02 MOTVE IOOR El CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIRIVERISTICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V `1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1GQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE76814
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5031
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 (a motorcycle) was traveling eastbound (southbound) in the 2500 blk of Maple Valley Hwy in
the right of two eastbound lanes approaching a left-hand curve. Unit 1 failed to negotiate this turn
and roadway markings indicate it struck the far right (south) curb. The motorcycle lost control and slid
on its side before impacting a concrete jersey barrier. The force of this impact catapulted the rider
over the ledge and down a vegetation embankment coming to rest in the Cedar River.
Rider 1 was treated at the scene by Renton Fire and Medics with indications of possible pelvic and
leg fractures. The presence of the odor of alcohol was perceived from the rider. Rider 1 was
transported to Harborview Medical Center for treatment. Unit 1 was impounded to the Renton City
Evidence garage.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 05-12-24 01:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 5/14/2024 8:05:35 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 3:01 PM TIME POLICE ARRIVED i 3:02 PM
PART I PAGE IT]OF
REPORT NO. EE76814 CASE# ' 24-5031 DATE AND TIME 05/11/24 14:59
OF COLLISION
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